Sepsis-Associated Acute Kidney Disease and Long-term Kidney Outcomes

Flannery, Alexander H.; Li, Xilong; Delozier, Natalie L.; Toto, Robert D.; Moe, Orson W.; Yee, Jerry; Neyra, Javier A.

doi:10.1016/j.xkme.2021.02.007

Cited by 21 publications

(18 citation statements)

References 37 publications

(62 reference statements)

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“…Adult studies have shown even more variability with incidence ranging from 3.8% in the general adult population of a single Canadian territory to 4.4%-74% in adults of special populations including those undergoing cardiac and non-cardiac procedure, chemotherapy, hematopoietic stem cell transplant recipients, those with AKI, heart failure, sepsis, cirrhosis, and SARS-CoV-2 infection (20). Hospitalized adults with AKI admitted to both the general floors as well as ICUs had high prevalence of AKD with most studies showing about one-fourth to half of all patients developing AKD (19,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Adults with cardiac diseases, post cardiac surgery, sepsis and cirrhosis all had high AKD prevalence suggesting hemodynamic status may play a significant role in sustained kidney injury and progression (17,18,(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)48).…”

Section: Epidemiology Of Akdmentioning

confidence: 99%

“…Hospitalized adults with AKI admitted to both the general floors as well as ICUs had high prevalence of AKD with most studies showing about one-fourth to half of all patients developing AKD (19,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Adults with cardiac diseases, post cardiac surgery, sepsis and cirrhosis all had high AKD prevalence suggesting hemodynamic status may play a significant role in sustained kidney injury and progression (17,18,(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)48). The wide variability in prevalence suggests there is a significant role for patient level and hospital acquired risk factors in the development of AKD after AKI.…”

Section: Epidemiology Of Akdmentioning

confidence: 99%

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Update on prognosis driven classification of pediatric AKI

Patel

Gbadegesin²

2022

Front. Pediatr.

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Acute kidney injury (AKI) affects a large proportion of hospitalized children and increases morbidity and mortality in this population. Initially thought to be a self-limiting condition with uniformly good prognosis, we now know that AKI can persist and progress to acute kidney disease (AKD) and chronic kidney disease (CKD). AKI is presently categorized by stage of injury defined by increase in creatinine, decrease in eGFR, or decrease in urine output. These commonly used biomarkers of acute kidney injury do not change until the injury is well established and are unable to detect early stage of the disease when intervention is likely to reverse injury. The kidneys have the ability to compensate and return serum creatinine to a normal or baseline level despite nephron loss in the setting of AKI possibly masking persistent dysfunction. Though these definitions are important, classifying children by their propensity for progression to AKD and CKD and defining these risk strata by other factors besides creatinine may allow for better prognosis driven discussion, expectation setting, and care for our patients. In order to develop a classification strategy, we must first be able to recognize children who are at risk for AKD and CKD based on modifiable and non-modifiable factors as well as early biomarkers that identify their risk of persistent injury. Prevention of initial injury, prompt evaluation and treatment if injury occurs, and mitigating further injury during the recovery period may be important factors in decreasing risk of AKD and CKD after AKI. This review will cover presently used definitions of AKI, AKD, and CKD, recent findings in epidemiology and risk factors for AKI to AKD to CKD progression, novel biomarkers for early identification of AKI and AKI that may progress to CKD and future directions for improving outcome in children with AKI.

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Section: Epidemiology Of Akdmentioning

confidence: 99%

Section: Epidemiology Of Akdmentioning

confidence: 99%

Update on prognosis driven classification of pediatric AKI

Patel

Gbadegesin²

2022

Front. Pediatr.

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“…Adult survivors of sepsis experience higher rates of new seizure disorder, cardiovascular events (eg, myocardial infarction and stroke), and both new and progressive chronic kidney disease compared with survivors of nonsepsis hospitalization. Moreover, this increased burden of development and progression of comorbid conditions has been shown to persist after adjustment for age and preexisting comorbid conditions . Although there is always risk for residual confounding in such observational studies, experimental preclinical studies have shown that murine sepsis is likewise associated with increased risk for the development and progression of comorbid disease (eg, atherosclerosis, cancer), further underscoring the association between sepsis and the long-term development and progression of comorbid conditions.…”

Section: Introductionmentioning

confidence: 99%

New and Progressive Medical Conditions After Pediatric Sepsis Hospitalization Requiring Critical Care

et al. 2022

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ImportanceChildren commonly experience physical, cognitive, or emotional sequelae after sepsis. However, little is known about the development or progression of medical conditions after pediatric sepsis.ObjectiveTo quantify the development and progression of 4 common conditions in the 6 months after sepsis and to assess whether they differed after hospitalization for sepsis vs nonsepsis among critically ill children.Design, Setting, and ParticipantsThis cohort study of 101 511 children (&lt;19 years) with sepsis or nonsepsis hospitalization used a national administrative claims database (January 1, 2010, to June 30, 2018). Data management and analysis were conducted from April 1, 2020, to July 7, 2022.ExposuresIntensive care unit hospitalization for sepsis vs all-cause intensive care unit hospitalizations, excluding sepsis.Main Outcomes and MeasuresPrimary outcomes were the development of 4 target conditions (chronic respiratory failure, seizure disorder, supplemental nutritional dependence, and chronic kidney disease) within 6 months of hospital discharge. Secondary outcomes were the progression of the 4 target conditions among children with the condition before hospitalization. Outcomes were identified via diagnostic and procedural codes, durable medical equipment codes, and prescription medications. Differences in the development and the progression of conditions between pediatric patients with sepsis and pediatric patients with nonsepsis who survived intensive care unit hospitalization were assessed using logistic regression with matching weights.ResultsA total of 5150 survivors of pediatric sepsis and 96 361 survivors of nonsepsis intensive care unit hospitalizations were identified; 2593 (50.3%) were female. The median age was 9.5 years (IQR, 3-15 years) in the sepsis cohort and 7 years (IQR, 2-13 years) in the nonsepsis cohort. Of the 5150 sepsis survivors, 670 (13.0%) developed a new target condition, and 385 of 1834 (21.0%) with a preexisting target condition had disease progression. A total of 998 of the 5150 survivors (19.4%) had development and/or progression of at least 1 condition. New conditions were more common among sepsis vs nonsepsis hospitalizations (new chronic respiratory failure: 4.6% vs 1.9%; odds ratio [OR], 2.54 [95% CI, 2.19-2.94]; new supplemental nutritional dependence: 7.9% vs 2.7%; OR, 3.17 [95% CI, 2.80-3.59]; and new chronic kidney disease: 1.1% vs 0.6%; OR, 1.65 [95% CI, 1.25-2.19]). New seizure disorder was less common (4.6% vs 6.0%; OR, 0.77 [95% CI, 0.66-0.89]). Progressive supplemental nutritional dependence was more common (1.5% vs 0.5%; OR, 2.95 [95% CI, 1.60-5.42]), progressive epilepsy was less common (33.7% vs 40.6%; OR, 0.74 [95% CI, 0.65-0.86]), and progressive respiratory failure (4.4% vs 3.3%; OR, 1.35 [95% CI, 0.89-2.04]) and progressive chronic kidney disease (7.9% vs 9.2%; OR, 0.84 [95% CI, 0.18-3.91]) were similar among survivors of sepsis vs nonsepsis admitted to an intensive care unit.Conclusions and RelevanceIn this national cohort of critically ill children who survived sepsis, 1 in 5 developed or had progression of a condition of interest after sepsis hospitalization, suggesting survivors of pediatric sepsis may benefit from structured follow-up to identify and treat new or worsening medical comorbid conditions.

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“…The incidence of AKI is approximately 22-51% among patients with sepsis and is strongly associated with subsequent failure of other organs and increased mortality. Moreover, patients with AKI have a higher risk for developing chronic kidney disease and end-stage renal disease, as well as long-term mortality after sepsis [4][5][6][7][8][9][10][11][12] .The pathophysiology of sepsis-AKI is complex and incompletely understood, which both hampers prompt recognition of AKI and the development of novel treatments to prevent or treat AKI. The KDIGO criteria are commonly used to diagnose and classify AKI 13,14 .…”

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confidence: 99%

mentioning

confidence: 99%

Plasma proteomic characterization of the development of acute kidney injury in early sepsis patients

Star

Boahen

Slikke

et al. 2022

Sci Rep

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Acute kidney injury (AKI) develops frequently in the course of patients with sepsis and strongly associates with in-hospital mortality. However, diagnosing AKI involves a considerable lag-time because it depends on assessing an increase in serum creatinine, and offers no insight in the underlying pathophysiology. Consequently, identifying a set of proteins reflecting the development of AKI may improve earlier recognition of AKI and the understanding of its pathophysiology. A targeted plasma proteomic approach was performed in early sepsis patients with and without subsequent AKI development in a matched pair design (n = 19 each). Principal component analysis identified 53 proteins associated with development of AKI, which were further analysed using Enrichr gene ontology and pathway analysis. Nine differentially expressed proteins from the targeted proteomics were increased among patients who subsequently developed AKI and correlated with principal components, namely CALCA, CALR, CA12, CLEC1A, PTK7, KIM-1, NPPC, NUCB2 and PGF. We demonstrated the biological insight in the development of AKI in early sepsis compared to non-AKI sepsis.

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Sepsis-Associated Acute Kidney Disease and Long-term Kidney Outcomes

Cited by 21 publications

References 37 publications

Update on prognosis driven classification of pediatric AKI

Update on prognosis driven classification of pediatric AKI

New and Progressive Medical Conditions After Pediatric Sepsis Hospitalization Requiring Critical Care

Plasma proteomic characterization of the development of acute kidney injury in early sepsis patients

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